Spontaneous intracranial hypotension (SIH) is a distinct form of headache that is often misdiagnosed in general practice. We describe a case of SIH in a 22-year-old man without any previous history of headaches. He presented at the Emergency Department with a typical orthostatic headache secondary to intracranial hypotension and low cerebrospinal fluid (CSF) pressure. Radioisotope cisternography confirmed a CSF leakage in the thoracic spine area. The patient was treated conservatively and recovered without sequelae. SIH is an increasingly recognized cause of headache. We review recent literature and remind emergency physicians that SIH should he included on the headache differential diagnosis list.